Dr. Matthew Schocket founded Capitol Pain Institute to provide progressive and innovative pain management in Austin and central Texas. Capitol Pain Institute provides expert pain management care and treatment in a truly multidisciplinary center that affords our patients the benefits of comprehensive care. The patient experience at Capitol Pain Institute begins with a face-to-face consultation with one of our pain management physicians. During this initial visit, a unique treatment plan is designed based on the specific individual needs of each patient.
We pledge to provide effective, efficient, and empathetic care to our patients, to preserve and promote the patient-physician relationship, and to contribute to the growth and well-being of our community.
Migraines are a severe type of headache that affects over 30 million Americans, with a 3:1 ratio of women to men. In some cases, these painful headaches are preceded or accompanied by an aura, such as flashes of light or blind spots. Migraine pain can be excruciating and may incapacitate you for hours or even days.
Although the exact cause of migraine is unclear, there is evidence that dysfunction of the trigeminal nerve (the nerve responsible for sensation in the face, forehead, and anterior scalp) and imbalances of certain neurotransmitters in the brain, especially serotonin, play a role in the development of migraine headaches. In addition, genetics also appears to play a role in the development of migraine headaches.
Spinal stenosis is a narrowing of one or more areas in your spine, most often in your upper or lower back. This narrowing can put pressure on spinal nerves or directly on the spinal cord. Spinal stenosis can cause cramping, pain or numbness in your legs, back, neck, shoulders or arms, a loss of sensation in your extremities, and problems with bladder or bowel function. Mild symptoms of spinal stenosis are often helped by conservative (non-surgical) treatments. In severe cases of spinal stenosis, surgery may be necessary to create additional space for the spinal cord or nerves. Although this usually provides some relief, it can not repair damaged nerves or stop the degenerative processes that often lead to spinal stenosis. Unfortunately, even after surgery, symptoms of spinal stenosis may recur or worsen over time.
Many people with spinal stenosis can be effectively treated with conservative measures. Surgery may be indicated if you have severe disabling pain and an inability to walk. Acute loss of bowel or bladder function is usually considered a medical emergency and requires immediate surgical intervention. Conservative treatments include:
Intervertebral discs are positioned in between each vertebral body (the bones of the spine). Each disc is composed of a tough outer ring (the annulus) and a soft gel-like inner core (the nucleus). Disc degeneration or acute injury can cause the nucleus to herniate into the spinal canal or the neural foramen. The herniated disc can directly compress a nerve root (radiculopathy) or disc material can irritate the nerve root (radiculitis), causing pain, numbness, and tingling radiating down the path of the nerve from the neck through the shoulder and into the arm and hand.
* These symptoms indicate a very serious condition, medical attention should be sought immediately
Treatment for a cervical disc herniation will largely depend on the length of time the patient has had symptoms and the severity of the pain. For most patients, symptoms from a cervical disc herniation will go away over time. Patients usually start with 3 to 6 months of conservative (non-surgical) treatments. Surgery may be considered if a course of conservative treatment does not provide pain relief,if the pain is too severe, or the patient is having difficulty functioning due to weakness. Conservative treatments include:
Intervertebral discs are positioned in between each vertebral body (the bones of the spine). Each disc is composed of a tough outer ring (the annulus) and a soft gel-like inner core (the nucleus). Disc degeneration or acute injury can cause the nucleus to herniate into the spinal canal or the neural foramen. The herniated disc material can irritate the nerve root (radiculitis), which can cause pain to radiate down the path of the nerve from the lower back through the buttocks and into the leg or even into the foot.
* These symptoms may indicate a very serious condition, medical attention should be sought immediately
Treatment for a lumbar disc herniation will largely depend on the length of time the patient has had symptoms and the severity of the pain. For most patients, symptoms from a lumbar disc herniation will go away over time. Patients usually start with 3 to 6 months of conservative (non-surgical) treatments. Surgery may be considered if a course of conservative treatment does not provide pain relief, or if the pain is too severe and the patient is having difficulty functioning. Conservative treatments include:
Back pain is the leading cause of occupational disability in the world and the most common cause of missed workdays. It is the second most common reason for visiting the doctor (first is the common cold). Studies report that up to 90% of adults will experience low back pain in their lifetime. It is important to understand, however, that “low back pain” is a term that encompasses many different types of anatomical injuries, from ligamentous and muscular injury, to herniated discs, vertebral body joint (facet) erosion, and nerve entrapment. At Capitol Pain Institute, we understand the many different causes of “low back pain,” and our doctors will design a treatment plan that is tailored to your specific pain symptoms.
The first step in treatment of low back pain is accurate diagnosis through a methodical and detailed history and physical examination. It is important to narrow down the cause of the low back pain as specific therapies work better for certain pain conditions. For example, a lumbar epidural steroid injection may be an excellent therapeutic choice for nerve impingement as a result of disc herniation whereas a radiofrequency rhizotomy may work best for facet arthropathy, and a lysis of adhesions procedure or spinal cord stimulator may be best served for patients with epidural scar formation post spine surgery.
Although serious episodes of low back pain are as likely to occur following activities of daily living as after moderate/severe trauma, a precipitating event can occasionally help pinpoint a pain source. Sacroiliac joint pain can be most often associated with a traumatic event such as a fall or a motor vehicle accident, whereas a herniated disc may be more likely to cause sciatica, an abrupt shooting “electric” pain down the leg with positional change.
Considering the different origins of low back pain, many different pharmacological medications are available to target your specific type of pain. Moreover, a multifaceted regimen consisting of physical/occupational therapy, interventional procedures appropriate to your condition, and innovative spinal cord stimulation strategies converge to provide you with an opportunity for excellent pain relief and regain of function.
Emerging on the horizon are regenerative treatment strategies designed to reverse or prevent further disc degenerations or erosion and enhance healing. As our practice prides itself on remaining up-to-date on the latest pain therapies, we are excited about the potential regenerative medicine holds for our patients. Regenerative medicine utilizes growth factors, gene therapy, and stem cells to promote healing.
Take home points:
What is a facet joint?
The facet joints link the vertebrae together and give them the flexibility to move against each other. There are two facet joints between each pair of vertebrae, one on each side. They extend and overlap each other to form a joint between the neighboring vertebra facet joint. The facet joints enable bending and twisting movements of the spine.
What is a medial branch nerve?
The medial branch is the branch of the spinal nerve that carries sensation and pain signals from the facet joint back to the spinal cord.
How do the facet joints cause pain?
The facet joints are just like any other joint in the body, they are succeptable to acute injury (sprain or strain) as well as degenerative arthritis. In the back, the facet joints may cause low back pain, hip and buttock pain, and leg pain. The pain is especially bad when leaning backwards or twisting your spine. The pain also tends to be worst first thing in the morning and in the evening.
What are the indications for a facet joint injection or medial branch block?
These injections are performed as a diagnostic test when it is thought that a facet joint or joints is part of the process that is causing the pain. A small amount of a local anesthetic is injected into the joint or over the medial branch nerve to see if this will temporarily relieve your back pain.
How long will the pain relief last after a facet joint injection or medial branch block?
The local anesthestic block will only last a few hours. A small amount of steroid may be injected along with the local anesthetic and may provide pain relief from days to months.
Can a facet joint injection make my pain worse?
Some patients will experience mild pain with the procedure that will ease up in a very short amount of time. On rare occasions, patients have experienced a prolonged increase in pain after the procedure.
What if a facet joint injection does not improve my pain?
Facet joint injections or medial branch blocks are performed to diagnose pain being caused by the facet joints in your back and will not relieve pain caused by intervertebral discs, spinal nerves, or muscles, which can continue to cause pain after the procedure. If your pain is not relieved after the procedure, the facet joints have been ruled out as the source of your pain.
What if the facet joint injection is successful?
If the facet joint injection successfully treat your pain for a significant period of time, they may be repeated as necessary. If the facet joint injection relieves your pain for a short period of time, then you will likely be scheduled for radiofrequency ablation (RFA) of the medial branch nerves.
Are there any restrictions following the facet joint injection?
We ask that you not immerse in water for 24 hours after the injections. This means that you can shower, but not take a bath or go swimming for the rest of the day. There are no other specific restrictions on activity however, we recommend that you “take it easy” the rest of the day and slowly resume your normal activities.
What are the risks of the facet joint injection?
Overall, facet joint injections (and medial branch blocks) are a very safe procedure. Serious side effects or complications are rare, however, like all injection procedures, possible adverse effects are possible. The most common complications include bleeding and bruising at the needle puncture site, post-procedure headaches, and lightheadedness or dizziness immediately following the procedure. Other very rare complications include transient numbness or weakness, paralysis (partial or complete), contrast or allergic reactions, sexual dysfunction, and death. If you experience any concerning symptoms after your injection, you should call your doctor immediately or go to an emergency room for evalulation.
What is a lumbar epidural steroid injection?
A lumbar epidural steroid injection (LESI) is an injection of corticosteroids (similar to cortisone) into the space just outside the covering (the dura) of the spinal cord in your lower back. Because the injection is outside (epi) the dura, it is called an epidural injection.
What are the indications for a lumbar epidural steroid injection?
These injections are performed when it is thought that spinal nerve inflammation is part of the process that is causing the pain. Common indications for lumbar epidural steroid injection include herniated discs, degenerative disc disease, radiculopathy or radiculitis, and spinal stenosis.
How do epidural steroid injections help my pain?
The spinal cord travels from the brain to the waist in a tunnel in the back part of the spine. About every inch along the way, the spinal cord gives off branches (spinal nerves) to the right and left. These spinal nerves carry sensations and pain signals from the various parts of the body back to the brain.
Corticosteroids are very potent anti-inflammatory medications that work best when they are injected into the area where the inflammation is occurring. Because the spinal nerves pass directly through the epidural space, a lumbar epidural steroid injection allows the medication (steroid) to come into direct contact with the inflamed spinal nerves, reducing the pain associated with the inflammation.
How do I prepare for a lumbar epidural steroid injection?
A lumbar epidural steroid injection is a minor surgical procedure that is typically performed in the physician’s office or an ambulatory surgery center. You should not eat or drink anything for at least 2 hours before your procedure. You should take all of your medicines except blood thinners the day of your procedure.
What should I expect during the lumbar epidural steroid injection?
You will be lying face-down on an X-ray table during the lumbar epidural steroid injection. You may have pillows placed under your abdomen to help your surgeon with optimal positioning. Live X-rays (called fluoroscopy) will then be taken to ensure proper positioning.
Your back will then be cleaned with an antiseptic solution and a sterile drape will be placed over this area to keep it clean for the procedure. A local anesthetic will then be injected into your skin to make it numb. The epidural needle with then be inserted thought the numbed skin and slowly advanced into the epidural space using fluoroscopy (live X-rays) to guide the needle. When the needle enters the epidural space, it is common to feel either a cold sensation or increased pressure in your lower back, buttocks, and legs.
Once the needle is in the epidural space, a small amount of contrast will be injected under live X-ray to ensure that the medication will spread properly. You will feel increased pressure during this injection. After this, the corticosteroid will be slowly injected into the epidural space. Again, it is very common to feel increased pressure during this part of the procedure. If the pressure becomes too painful, you should let your surgeon know immediately. Once the injection is complete, the needle will be withdrawn and a dressing will be placed over the injection site.
Can I have sedation for the lumbar epidural steroid injection?
The vast majority of patients do not require sedation for the lumbar epidural steroid injection, however, we will provide light sedation for the procedure at your request. Patients who are receiving sedation must have a responsible adult with them to drive them home.
How soon can I go home after a lumbar epidural steroid injection?
Your blood pressure, pulse, and breathing will be checked frequently over the next 15 to 20 minutes. Once your vital signs are stable, you will be able to go home.
Can I drive myself or do I need a ride?
Most patients prefer to have a family member or friend drive them for their lumbar epidural steroid injection, however, you may drive yourself to the procedure as long as you are not requesting sedation.
How long will it take for the pain relief to take effect after the lumbar epidural steroid injection?
Some patients will experience immediate relief after the lumbar epidural steroid injection, however, it usually takes 24 to 72 hours for the effects of the steroid medication to take effect and it may be up to 1 week before the maximum benefits are achieved. Very often more than 1 injection is necessary to achieve a good level of pain relief.
What is Platelet Rich Plasma (PRP)?
Platelet Rich Plasma is an advanced regenerative medicine therapy that utilizes the body’s own natural healing mechanisms to heal injured soft tissue, including tendons, muscles, and ligaments. Platelet Rich Plasma (PRP) is produced from the patient’s own blood by taking a blood sample (the same as having your blood drawn at the lab) and then processing that sample in a centrifuge. This processing allows us to extract a small amount of plasma with a very high concentration of platelets – this is the Platelet Rich Plasma (PRP). The Platelet Rich Plasma (PRP) is then injected into the injured area to help promote healing.
How does Platelet Rich Plasma (PRP) work?
Platelet Rich Plasma (PRP) works several ways. First, Platelet Rich Plasma (PRP) initiates wound repair by releasing specialized growth factors to activate and amplify the body’s natural healing mechanisms. Second, Platelet Rich Plasma (PRP) suppresses cytokine release and limits localized inflammation, which allows for improved tissue healing and regeneration. Finally, Platelet Rich Plasma (PRP) produces specialized signaling proteins that attract white blood cells (WBCs), enhancing the body’s ability to fight localized infections.
How do I prepare for Platelet Rich Plasma (PRP) therapy?
Platelet Rich Plasma (PRP) therapy is a minor injection procedure that is typically performed in our office at Capitol Pain Institute. Patients should not use any corticosteroid medications for 2-3 weeks or nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 1 week prior to the procedure. It is recommended that patients increase their fluid intake for 24-48 hours prior to Platelet Rich Plasma (PRP) therapy.
What should I expect during Platelet Rich Plasma (PRP) therapy?
The first step in Platelet Rich Plasma (PRP) therapy is to draw the blood sample. This is done in the pre-procedure room using a butterfly (no different than going to the lab and having your blood drawn for lab tests). Once this is complete, the blood is put into a specialized container and placed in the centrifuge for processing. It takes about 15 minutes for the processing to be completed.
During the processing time, you will be taken to the procedure room. If your have requested IV sedation for the procedure, then we will start your IV during this time. The area to be injected will be cleaned with an antiseptic solution and a sterile drape will be placed over this area to keep it clean for the procedure. A local anesthetic will then be injected into your skin to make it numb. After this, either ultrasound or fluoroscopy (live X-ray) will be used to guide the injection needle to the proper injection site. The Platelet Rich Plasma (PRP) will then be injected into the site and the needle will be removed.
What should I expect after Platelet Rich Plasma (PRP) therapy?
Most patients experience soreness after the procedure that lasts from 1-10 days. The soreness is a result of the healing cascade beginning and it is actually a good thing – it means that the Platelet Rich Plasma (PRP) is starting to work. Most patients start to feel relief from the Platelet Rich Plasma (PRP) about 2-4 weeks after the procedure.
What is the recovery time for Platelet Rich Plasma (PRP)?
The first 24 hours after Platelet Rich Plasma (PRP) is critical for allowing the Platelet Rich Plasma (PRP) to begin working. Therefore, at Capitol Pain Institute, we recommend extremely limited activity for the first 24 hours after injection and then light activity for the 1st week following Platelet Rich Plasma (PRP) therapy. After the 1st week, patients may slowly increase their activity back to normal levels.
Can I have sedation for the Platelet Rich Plasma (PRP) therapy?
The vast majority of patients do not require sedation for thePlatelet Rich Plasma (PRP) therapy, however, we will provide light sedation for the procedure at your request. Patients who are receiving sedation must have a responsible adult with them to drive them home.
Can I drive myself or do I need a ride for Platelet Rich Plasma (PRP) therapy?
Most patients prefer to have a family member or friend drive them for their Platelet Rich Plasma (PRP) therapy, however, you may drive yourself to the procedure as long as you are not requesting sedation.